The use of emergency medication kits in community palliative care: An exploratory survey of views of current practice in Australian home-based palliative care services

Improving symptom management for palliative care patients has obvious benefits for patients and advantages for the clinicians, as workload demands and work-related stress can be reduced when the emergent symptoms of patients are managed in a timely manner. The use of emergency medication kits (EMKs) can provide such timely symptom relief. The purpose of this study was to conduct a survey of a local service to examine views on medication management before and after the implementation of an EMK and to conduct a nationwide prevalence survey examining the use of EMKs in Australia. Most respondents from community palliative care services indicated that EMKs were not being supplied to palliative care patients but believed such an intervention could improve patient care.

Theory and practice of automotive modal lock-in – an Indonesian case

This thesis examines the question why the automotive mode and the large technological system it creates, continues to dominate urban transport systems despite the availability of more cost-efficient alternatives. A number of theoretical insights are developed into the way these losses evolve from path dependent growth, and lead to market failure and lock-in. The important role of asymmetries of influence is highlighted. A survey of commuters in Jakarta Indonesia is used to provide a measure of transport modal lock-in (TML) in a developing country conurbation. A discrete choice experiment is used to provide evidence for the thesis central hypothesis that in such conurbations there is a high level of commuter awareness of the negative externalities generated by TML which can produce a strong level of support for its reversal. Why TML nevertheless remains a strong and durable feature of the transport system is examined with reference to the role of asymmetries of influence.

Deterrence of drug driving : the impact of the ACT drug driving legislation and detection techniques

Overarching Research Questions Are ACT motorists aware of roadside saliva based drug testing operations? What is the perceived deterrent impact of the operations? What factors are predictive of future intentions to drug drive? What are the differences between key subgroups

Good Practice Report : Postgraduate Research and Coursework Degrees

Over the past decade, enrolments in postgraduate courses in Australian universities have risen by 34% (or from 258,164 in 2004 to 347,363 in 2013) (uCube, 2014). This substantial growth can be attributed to increased demand for postgraduate coursework as continuing professional education, the expansion of Higher Degrees Research (HDR) intakes, and the development of postgraduate research and coursework degrees in new fields. At the same time, the establishment of the Australian Qualification Framework (AQF) and national Tertiary Education Quality and Standards Agency (TEQSA), as well as the internationalisation of postgraduate education, have brought challenges and opportunities to the sector. During the past five years, the Australian Government Office for Learning and Teaching (OLT) and its predecessor bodies have funded a number of projects and Fellowships on postgraduate coursework and research degrees. They span diverse topics–from entry pathways and research training to supporting international and Indigenous students, examination, scoping studies of new and emergent programs, and effective supervision. In 2014 the OLT commissioned this good practice report to review the grants and fellowships conducted between 2009 and 2014. Encompassing twenty-seven learning and teaching projects and fellowships, the aims of this report include providing universities and academics with an overview of the current state of postgraduate study in Australia and the major influences upon it; a coherent overview of funded projects’ findings and outcomes; and a central point to access good practices, resources and tools in summary form. The objectives of this good practice report are to provide: • A literature review, which contextualises the projects within the Australian and international Higher Education environment, emphasises factors that currently influence postgraduate programs, and highlights challenges and opportunities for the sector. It also explains variations in postgraduate course types and definitions within the Australian Qualification Framework (AQF), and identifies key learning and teaching issues as well as good practices identified in scholarly research and position papers. • A collated overview of the twenty-seven national learning and teaching projects and fellowships on postgraduate coursework and research, including a summary of each project’s aims and objectives, methodologies, outcomes and resources. • A summative index of project characteristics (topics, themes and approaches) and inventory of scholarly research outcomes of the completed projects (publications, reports) as well as resources produced (tools, methods, good practice case studies), and their location (URL Links, references, etc.). • A summary of good practices that have been identified from the literature and the findings of completed projects. • A set of recommendations to address remaining gaps in the field and areas in which further work or development are appropriate. Bringing this work together will help enable university course teams to improve the delivery and development of existing postgraduate courses and to develop new ones, and it will provide academics with an overview of good practices and resources for teaching, supervising and supporting postgraduate students.

Investigating design for disassembly through creative practice

The construction industry is responsible for a significant part of the solid waste that industrialised nations dispose of each year. One reason for this is the inability to easily separate materials and components from each other and from the building structure. If buildings were designed for disassembly in the first instance, then future material and component recovery would be easier. This paper presents a number of principles for design for disassembly that have been tested and developed through a process of research through creative practice. A number of architectural designs have been used to trial the principles in practice.

Influence of practice setting on contact lens prescribing in the United Kingdom

We sought to determine the impact of optometric practice setting on contact lens prescribing by analysing annual survey data of lens fits collected between 2009 and 2013 from independent and national group practices throughout the United Kingdom. Compared to national group practices, independent practices fit contact lenses to older patients and more females. Independent practices also undertake a lower proportion of soft lens fits overall (and thus a higher proportion of rigid lens fits), soft toric lens fits and daily disposable lens fits. There is a higher proportion of soft extended wear and multifocal lens fits in independent practices. We conclude that contact lens fitting behaviour is influenced by optometric practice setting.

Best practice in peer-led curriculum content : informing an interactive program to improve passenger safety among high school seniors

Despite ongoing improvements in behaviour change strategies, licensing models and road law enforcement measures young drivers remain significantly over-represented in fatal and non-fatal road related crashes. This paper focuses on the safety of those approaching driving age and identifies both high priority road safety messages and relevant peer-led strategies to guide the development school programs. It summarises the review in a program logic model built around the messages and identified curriculum elements, as they may be best operationalised within the licensing and school contexts in Victoria. This paper summarises a review of common deliberate risk-taking and non-deliberate unsafe driving behaviours among novice drivers, highlighting risks associated with speeding, driving while fatigued, driving while impaired and carrying passengers. Common beliefs of young people that predict risky driving were reviewed, particularly with consideration of those beliefs that can be operationalised in a behaviour change school program. Key components of adolescent risk behaviour change programs were also reviewed, which identified a number of strategies for incorporation in a school based behaviour change program, including: a well-structured theoretical design and delivery, thoughtfully considered peer-selected processes, adequate training and supervision of peer facilitators, a process for monitoring and sustainability, and interactive delivery and participant discussions. The research base is then summarised in a program logic model with further discussion about the quality of the current state of knowledge of evaluation of behaviour change programs and the need for considerable development in program evaluation.

Piecing the puzzle together : enhancing the quality of road trauma surveillance through linkage of police and health data

This program of research linked police and health data collections to investigate the potential benefits for road safety in terms of enhancing the quality of data. This research has important implications for road safety because, although police collected data has historically underpinned efforts in the area, it is known that many road crashes are not reported to police and that these data lack specific injury severity information. This research shows that data linkage provides a more accurate quantification of the severity and prevalence of road crash injuries which is essential for: prioritising funding; targeting interventions; and estimating the burden and cost of road trauma.

Patient group directions : the application and integration of knowledge in advancing nursing practice

Background: The introduction of Patient Group Directions (PGD) has changed significantly the way in which nurses can now administer prescription only medicines as a one-off for patients requiring this level of service. PGD’s are a written authority to administer drugs to patients that are not identified at the time of treatment. Aim: The aim of this project was to develop a PGD for use within an Outreach team to administer colloid boluses to patients presenting with hypovolemia. Method: Using a case exemplar this paper will discuss the development of a PGD using aspects of transitional change theory to highlight the potential barriers that were encountered. Implications for Practice: The implications for this PGD are wide reaching. First it now enables members from the nursing Outreach team to administer colloid fluid boluses to a prescribed patient cohort without the need for prescription. Second, it ensures the deteriorating patient has interventions initiated in a timely and appropriate manner to reduce inadvertent admission to high care areas. Last, it will improve inter-professional team-working and communication so much so that collaborative patient care reduces health costs and identifies earlier those patients requiring substantially greater nursing and medical input. Conclusion: The experience of developing a working PGD for fluid administration has meant that the Outreach team is able to respond to patients in a more effective way. In addition, it is the experience of developing this PGD that has enabled the team to contemplate other PGD’s in the execution of Outreach work.

Meeting the nutrition challenge of stage 3 renal failure : considerations for nursing practice

Self-care management is needed for effective management of chronic kidney disease. The main aim for treatment or management of chronic kidney disease is to delay the worsening of kidney function, and to prevent or to manage the co-morbidities. Selfcare management is not easy, and patients will face many challenges, especially when they cannot get use to the new treatment plan. One of the challenges they face is dietary restriction, which is a very important aspect in any self-care management programme. Chronic kidney disease patients require a low-protein, low-sodium, low-potassium, and low-phosphorus diet. There are several strategies patients can undertake to ensure adherence, such as self-monitoring their dietary habits and type of food consumed using a food diary; involving social support, such as family members and spouse to help them to adhere to their diet restrictions; setting goals and providing positive reinforcement when they achieved the targeted goals; joining self-management programmes to equip themselves with the necessary skills so that they can better adhere to the treatment regimes, including diet restriction; and lastly, having the knowledge about their regime, and using this knowledge to help them understand and improve their adherence.

The pathophysiology of ischaemic stroke : considerations for emergency department advanced practice nursing

Stroke is the fourth most important cause of death in Singapore. Its major predisposing factors include hypertension, type 2 diabetes mellitus and hyperlipidaemia; all modifiable diseases if treated early. However, with Singapore’s elderly population, the risk and rates of stroke are ever increasing. The nature of a stroke can be categorised as eitherh aemorrhagic or ischaemic; the former caused by arterial rupture, the latter by arterial blockage; both can be devastating in their prognosis and outcome. This paper will discuss the pathophysiology of ischaemic stroke while identifying some of the key features of ischaemia on different areas of the brain relative to the artery that feeds them. Thoughts for Emergency Department advanced practice nursing will also be discussed.

Alarm setting for the critically ill patient : A descriptive pilot survey of nurses’ perceptions of current practice in an Australian Regional Critical Care Unit

Aim: The aim of this survey was to assess registered nurse’s perceptions of alarm setting and management in an Australian Regional Critical Care Unit. Background: The setting and management of alarms within the critical care environment is one of the key responsibilities of the nurse in this area. However, with up to 99% of alarms potentially being false-positives it is easy for the nurse to become desensitised or fatigued by incessant alarms; in some cases up to 400 per patient per day. Inadvertently ignoring, silencing or disabling alarms can have deleterious implications for the patient and nurse. Method: A total population sample of 48 nursing staff from a 13 bedded ICU/HDU/CCU within regional Australia were asked to participate. A 10 item open-ended and multiple choice questionnaire was distributed to determine their perceptions and attitudes of alarm setting and management within this clinical area. Results: Two key themes were identified from the open-ended questions: attitudes towards inappropriate alarm settings and annoyance at delayed responses to alarms. A significant number of respondents (93%) agreed that alarm fatigue can result in alarm desensitisation and the disabling of alarms, whilst 81% suggested the key factors are those associated with false-positive alarms and inappropriately set alarms.

The Australian practice pharmacist

Background: Evolution in Australian community pharmacy and general practice environments has seen the emergence of a new opportunity for pharmacist practice, distinct from the conventional community and hospital settings, in which the pharmacist is integrated into the general practice setting to provide professional services. Aim: To characterise pharmacists practising in the Australian general practice setting. Method: An electronic questionnaire. Results: Twenty-six practice pharmacists completed the questionnaire. Practice pharmacists were more likely to be female, aged between 30 and 49 years, have postgraduate qualifications and also work in other pharmacy sectors. The general practice settings more frequently had multiple general practitioners and also housed multiple allied health professionals. The most commonly conducted services provided by the practice pharmacists were Home Medicine Reviews, responding to clinical enquiries from general practitioners and responding to enquiries from other health professionals. Most practice pharmacists worked as independent contractors for services provided. The practice pharmacists provided some services in the absence of remuneration. The majority of practice pharmacists agreed or strongly agreed that a set of competencies should be developed and a credentialing process required with experience of the pharmacist being regarded highly. Conclusion: The results of this study have described the variety of professional roles, remuneration and characteristics in a small sample of pharmacists practising in a general practice setting in Australia. For this model of pharmacist practice to expand an appropriate method of remuneration is required.